Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

The report by the Centers for Disease Control and Prevention ranked states on 15 indicators that present a picture of health among people age 65 and older.

Hawaii ranked No. 1 in keeping physically active, not smoking, staying slim, a small number reporting a disability and a low number of physically unhealthy days.

The state's older population didn't do well in every area, however, ranking 49th in the number of older adults who get colonoscopies and 42nd in the number of older women who have had mammograms in the past two years.

While the report shows strengths in Hawaii's elderly population, it doesn't show some health issues specific to the state's diverse population, said Dr. Chiyome Fukino, the state health director. For example, Native Hawaiians and Filipinos show higher rates of some cancers, which didn't turn up in this report, she said.

"As far as not being obese, a lot of the elderly folks are Asian and they're not overweight," she said.

Hawaii also ranked 48th for seniors who eat five or more fruits and vegetables each day.

Many older people eat less because of a loss of appetite, while others don't want to spend a lot of time selecting and preparing fruits and vegetables, Fukino said.